Change in students' critical thinking over the course of dental education.

PURPOSE: The purpose of this study was to test whether critical thinking changes over the course of dental education by assessing dental students at the beginning and toward the end of their training. METHODS: Dental student participants completed a survey at the beginning of their first year (August 2019) and at the start of their last year of dental school (August 2022). The survey consisted of two instruments designed to measure the disposition and metacognition components of critical thinking. The study used a pretest-posttest design. Paired t tests were used to determine whether critical thinking scores changed over the 3-year period. RESULTS: Surveys were completed by 85 of 94 students (90%) on the pretest and 63 of 93 students (68%) on the posttest. Of the 92 students who were members of the class at both testing periods, data were available for 59 students (64%). There were significant mean decreases in disposition and its tolerance for cognitive complexity subscale, as well as in metacognition and its metacognitive strategies subscale (p < .05). There was no significant mean change in either open-mindedness or metacognitive thinking. CONCLUSION: Results of this study suggest that some aspects of critical thinking (metacognition and disposition) decrease over the course of dental education. Future research should investigate why this is the case, and explore different instructional methods designed to improve critical thinking.

Immediate Effect of Ultrasound on Bilateral Masseter Myalgia: A Randomized Dose-Response Clinical Trial.

AIMS: (1) To determine the dose-response relationship of therapeutic ultrasound for TMD-related pain in the masseter muscle among four doses comprised of two intensities (0.4 W/cm2 and 0.8 W/cm2) and two duty cycles (50% and 100%); and (2) to determine if therapeutic ultrasound applied to the masseter muscle would elicit a segmental effect on the ipsilateral temporalis muscle. METHODS: A total of 28 adult women with bilateral myalgia were randomly allocated to one of the four intervention doses. Therapeutic ultrasound was applied on each side of the masseter sequentially for 5 minutes. The following outcomes were measured before and immediately after each intervention: self-reported pain score, pressure pain thresholds for the masseter and temporalis muscles, and intraoral temperature adjacent to the treated masseter. RESULTS: Self-reported pain scores showed neither significant main effects nor significant interaction among the intensity or duty cycle doses (all P > .05). The change in the pressure pain threshold of the masseter showed a significant interaction (P = .02) attributed to the 0.4 W/cm2 and 100% duty cycle dose. Intraoral temperature was significantly increased and associated with the duty cycle (P = .01). A significant segmental effect of the pressure pain threshold of the temporalis was found for intensity (P = .01). CONCLUSION: There was an increase in the pressure pain threshold of the painful masticatory muscles and an increase in intraoral temperature adjacent to the treated area immediately after the use of ultrasound at 0.4 W/cm2 with a 100% duty cycle.

Psychometric properties of an instrument to assess critical thinking disposition and metacognition in dental students.

OBJECTIVE: The purpose of this study was to determine the psychometric properties of instruments designed to assess the critical thinking domains of disposition and metacognition in a dental student population. METHODS: Two instruments originally developed to assess disposition and metacognition domains in undergraduate student populations were administered to dental students from 3 classes in the Spring of 2019. The overall response rate was 73%. Sampling adequacy was established for both domains. Exploratory factor analysis was used to determine underlying dimensions. Criterion validity was established by correlation with traditional measures of academic achievement. RESULTS: Kaiser-Meyer-Olkin index (>0.80) and Bartlett's test of sphericity (P < 0.005) indicated sampling adequacy for both domains. Factor analysis supported a 2-factor solution for Disposition (Level of Open Mindedness and Tolerance for Cognitive Complexity) and a 2-factor solution for Metacognition (Metacognitive Thinking and Metacognitive Strategies). Items loading at 0.4 or higher were retained. Cronbach's alpha was above 0.8 for all but the Metacognitive Thinking subscale, which nonetheless showed adequate reliability (0.65). Reliability for Disposition and Metacognition scales was also above 0.8. CONCLUSION: These results indicate that the instrument has sufficient validity and reliability to support further use in dental education.

A Systematic Review of Critical Thinking Instruments for Use in Dental Education.

Critical thinking is widely recognized as an essential competency in dental education, but there is little agreement on how it should be assessed. The aim of this systematic review was to determine the availability of instruments that could be used to measure critical thinking in dental students and to evaluate psychometric evidence to support their use. In January 2017, an electronic search of both the medical and education literature was performed on nine databases. The search included both keyword and Medical Subject Heading terms for critical thinking, higher education/health sciences education, measurement/assessment, and reproducibility of results. The grey literature was included in the search. The search produced 2,977 unique records. From the title and abstract review, 183 articles were selected for further review, which resulted in 36 articles for data extraction. Ten of these studies sought to evaluate psychometric properties of the instruments used and were subjected to quality assessment. Seven assessment instruments were identified. Of these, three instruments that have not been widely used nor tested in health professions students showed evidence of psychometric strength and appeared to have potential for use in dental education. Further research should focus on the three critical thinking instruments with strong psychometric evidence, with the aim of establishing validity and reliability in the context of dental education.

Immediate Effect of Continuous Ultrasound vs Sham Ultrasound for Bilateral Masseter Myalgia: A Double-Blinded Trial.

AIMS: To investigate the local and segmental effects of therapeutic ultrasound at a dose of 0.4 w/cm2 with 100% duty cycle for 5 minutes compared to the effect of sham ultrasound on painful masticatory muscles. METHODS: A total of 20 adult female subjects with bilateral masseter myalgia diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were included. Each subject was randomized to either an active ultrasound group or a sham ultrasound group. The intervention was applied to each masseter muscle for 5 minutes. Measures included pre- and post-self-reported pain intensity recorded on a verbal rating scale (VRS), pressure pain thresholds for the masseter (PPT-M) and temporalis (PPT-T) muscles, and intraoral temperature for the masseter muscle. Preintervention score was subtracted from the postintervention score for all measures to calculate mean change in pain, and nonparametric Mann-Whitney test was used to compare the groups. Statistical significance was set at P < .05. RESULTS: Changes in VRS did not show a significant difference between groups (P > .05). There were significant increases in PPT-M and intraoral temperature in the ultrasound group compared to the sham group (P < .05). There was no significant difference in PPT-T (P > .05), suggesting no segmental effect. CONCLUSION: Therapeutic ultrasound produced an immediate increase in PPT-M and intraoral temperature compared to sham ultrasound in female subjects with bilateral masseter myalgia.

Reliability and diagnostic validity of a joint vibration analysis device.

BACKGROUND: This observational study was designed to evaluate the reliability and diagnostic validity of Joint Vibration Analysis (JVA) in subjects with bilateral disc displacement with reduction and in subjects with bilateral normal disc position. METHODS: The reliability of selecting the traces was assessed by reading the same traces at an interval of 30 days. The reliability of the vibrations provided by the subjects was assessed by obtaining two tracings from each individual at an interval of 30 min. The validity compared the Joint Vibration Analysis parameters against magnetic resonance imaging as the reference standard. The data were analyzed with exploratory factor analysis. RESULTS: The short- term reliability of the Joint Vibration Analysis outcome variables showed excellent results. Implementing factor analysis and a receiver operating characteristic as analytical methods showed that six items of the Joint Vibration Analysis outcome variables could be scaled and normalized to a composite score which presented acceptable levels of sensitivity and specificity with a receiver operating characteristic of 0.8. CONCLUSION: This study demonstrated that the composite score generated from the Joint Vibration Analysis variables could discriminate between subjects with bilateral normal versus bilateral displaced discs.

Observed infection control compliance in a dental school: A natural experiment.

OBJECTIVE: The objective of this study was to determine student adherence to infection control policies at 1 dental school. A secondary objective was to determine the influence of Ebola virus disease (EVD)-related training on student infection control behaviors. METHODS: An instrument to assess and record infection control behaviors was developed to reflect Centers for Disease Control and Prevention guidelines as well as current teaching. Third- and fourth-year dental students were observed during patient-care appointments and behaviors were recorded and analyzed. Behaviors observed before the EVD outbreak and subsequent mandatory in-service training were compared with behaviors observed after completion of the training. RESULTS: Use of personal protective equipment was nearly universal. Overall compliance with infection control parameters was 88%. However, only a minority of students demonstrated no breaches of protocol. Most violations involved improper mask use and improper glove use during the intraoperative phase of an appointment and failure to wash hands after removing gloves. There were no significant overall differences in observed behavior pre- and post-EVD training. CONCLUSION: Overall compliance with recommendations was high but some areas showed room for improvement. Future training in infection control should focus on these areas. Training related to EVD had no influence on student behavior.

Dental students' glucometer experience and attitudes toward diabetes counseling, monitoring, and screening: a comparative study.

The objectives of this study were to compare glucometer experience and attitudes toward counseling, monitoring, and screening for diabetes between two classes of graduating students at one dental school to determine if there were differences by experience and year of graduation. Dental students graduating in 2010 and 2013 completed a survey about their experience with use of a glucometer as well as their attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling. Response rates for the two classes were 100 percent and 95.7 percent, respectively. Students in the two classes were in general agreement that activities related to glucose monitoring and counseling of patients with diabetes are within the scope and responsibility of the dental profession. Examination of their attitudes toward diabetes monitoring and counseling activities by level of glucometer experience indicated that students with more experience using a glucometer were more likely to consider these activities to be within the scope of dental practice and less likely to perceive barriers to such activities compared to those with little or no experience. In addition, regardless of experience, there was significantly higher endorsement for monitoring of patients who had already been diagnosed than for screening of patients who had not been diagnosed. This study suggests that any strategy to encourage dental students' and dentists' involvement in nontraditional health promotion activities should include ample direct clinical experience with these activities.

Dental students' attitudes toward diabetes counseling, monitoring, and screening.

The main objective of this study was to examine attitudes of dental students toward chairside counseling and monitoring of and screening for diabetes. A secondary objective was to examine the psychometric properties of the survey instrument. First- and fourth-year students at one dental school completed a survey examining attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling in a dental setting. Surveys were completed by seventy-one of ninety first-year dental students (79 percent) and eighty-six fourth-year students (100 percent) for a total of 157 responses. Factor analysis of the survey instrument resulted in a three-factor solution: scope and responsibility, barriers, and glucometer use. In analyses to determine whether there were differences in attitudes by gender, level of education, or family history of diabetes, no statistically significant effects were seen. The dental students were in general agreement that glucose monitoring of patients diagnosed with diabetes is within the scope and responsibility of the dental profession; however, only a minority endorsed screening of patients who have not been diagnosed with diabetes. Psychometric analysis revealed internal reliability of the survey instrument.

Dental students' attitudes toward tobacco cessation counseling.

The main objective of this study was to determine if level of education, gender, and tobacco history affected attitudes of dental students toward tobacco cessation counseling. A secondary objective was to examine the psychometric properties of the survey instrument. First- and fourth-year dental students at one school of dental medicine completed a survey examining attitudes toward tobacco cessation and perceived barriers to performing tobacco cessation counseling in a dental setting. Analyses were conducted to determine whether there were differences in attitudes by gender, level of education, or personal and family tobacco use. A main effect for education level was discovered. Fourth-year students were more likely than first-year students to consider the prescription of nicotine gum and transdermal patches to be within the scope and responsibility of the dental profession. No significant differences were seen with regard to gender or students' personal and family tobacco histories. Dental students were in general agreement that tobacco cessation counseling is within the responsibility of the dental profession, is within the scope of dental practice, and can be effective. Psychometric analysis revealed reliability of the survey instrument.

Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders.

AIMS: To conduct a systematic review of papers reporting the reliability and diagnostic validity of the joint vibration analysis (JVA) for diagnosis of temporomandibular disorders (TMD). METHODS: A search of Pubmed identified English-language publications of the reliability and diagnostic validity of the JVA. Guidelines were adapted from applied STAndards for the Reporting of Diagnostic accuracy studies (STARD) to evaluate the publications. RESULTS: Fifteen publications were included in this review, each of which presented methodological limitations. CONCLUSION: This literature is unable to provide evidence to support the reliability and diagnostic validity of the JVA for diagnosis of TMD.

Electromyographic power spectrum of jaw muscles during clenching in unilateral temporomandibular joint osteoarthritis patients.

The relationship between temporomandibular joints (TMJ) osteoarthritis and masticatory muscle disorders is poorly understood. The data are sparse, the results are conflicting, and electromyographic (EMG) power spectrum analysis has not been used. The aims of this study were to compare the differences in EMG power spectrum during, and pressure pain thresholds (PPTs) before and after, sustained clenching in patients with unilateral TMJ osteoarthritis and healthy control subjects. Nineteen patients with unilateral TMJ osteoarthritis without masticatory muscle pain and 20 control subjects were evaluated. We measured EMG amplitudes at maximum voluntary contraction, median frequency from the EMG power spectrum during sustained clenching at 70% and PPTs before and after the clenching in both temporalis and masseter muscles. There were no significant differences in PPT decrease between muscles or between groups during sustained clenching. There were no significant differences in maximum voluntary contraction EMG activity ratios of affected to unaffected sides between groups, or of masseter to temporalis muscles between affected and unaffected side of patients with TMJ osteoarthritis. Median frequencies decreased from the beginning to the end of the sustained clench, and the interaction between group and clench was significant: the median frequency decrease was larger in the osteoarthritis group. Our results suggested that masticatory muscles of patients with unilateral TMJ osteoarthritis are more easily fatigued during sustained clenching than normal subjects.

Muscle organization in individuals with and without pain and joint dysfunction.

Central nervous system organization of masticatory muscles determines the magnitude of joint and muscle forces. Validated computer-assisted models of neuromuscular organization during biting were used to determine organization in individuals with and without temporomandibular disorders (TMD). Ninety-one individuals (47 women, 44 men) were assigned to one of four diagnostic groups based on the presence (+) or absence (-) of pain (P) and bilateral temporomandibular joint disc displacement (DD). Electromyography and bite-forces were measured during right and left incisor and molar biting. Two three-dimensional models employing neuromuscular objectives of minimization of joint loads (MJL) or muscle effort (MME) simulated biting tasks. Evaluations of diagnostic group and gender effects on choice of best-fit model were by analysis of variance (ANOVA) and Tukey-Kramer post hoc tests, evaluations of right-left symmetry were by Chi-square and Fisher's exact statistics, and evaluations of model accuracy were by within-subject linear regressions. MME was the best-fit during left molar biting in +DD individuals and incisor biting in men (all p < 0.03). Incisor biting symmetry in muscle organization was significantly higher (p < 0.03) in healthy individuals compared with those with TMD. Within-subject regressions showed that best-fit model errors were similar among groups: 8 to 15% (0.68 ≤ R(2) ≤ 0.74). These computer-assisted models predicted muscle organization during static biting in humans with and without TMDs.

Reliability of electromyographic activity vs. bite-force from human masticatory muscles.

The reproducibility of electromyographic (EMG) activity in relation to static bite-force from masticatory muscles for a given biting situation is largely unknown. Our aim was to evaluate the reliability of EMG activity in relation to static bite-force in humans. Eighty-four subjects produced five unilateral static bites of different forces at different biting positions on molars and incisors, at two separate sessions, and the surface EMG activities were recorded from temporalis, masseter, and suprahyoid muscles bilaterally. Intraclass correlation coefficients (ICCs) were determined, and an ICC of ≥ 0.60 indicated good reliability of these slopes. The ICCs for jaw-closing muscles during molar biting were: temporalis muscles, ipsilateral 0.58-0.93 and contralateral 0.88-0.91; and masseter muscles, ipsilateral 0.75-0.86 and contralateral 0.69-0.88. The ICCs for jaw-closing muscles during incisor biting were: temporalis muscles, ipsilateral 0.56-0.81 and contralateral 0.34-0.86; and masseter muscles, ipsilateral 0.65-0.78 and contralateral 0.59-0.80. For the suprahyoid muscles the 95% CIs were mostly wide and most included zero. The slopes of the EMG activity vs. bite-force for a given biting situation were reliable for temporalis and masseter muscles. These results support the use of these outcome measurements for the estimation and validation of mechanical models of the masticatory system.

Inflammatory response to dental polishing and prophylaxis materials in rats.

OBJECTIVE: To describe the tissue response to implanted polishing and prophylaxis materials using a rat model system. MATERIAL AND METHODS: Two polishing pastes (diamond polishing paste and aluminum polishing paste), two prophylaxis materials (prophylaxis paste with fluoride and air polishing prophylaxis powder) and negative and positive controls were subcutaneously implanted in rats. Tissue specimens obtained after 2 days, 1, 4, 6 and 8 weeks after implantation were processed for routine hematoxylin and eosin staining and polarized light evaluation. RESULTS: Air polishing prophylaxis powder produced a mild inflammatory response. A more intense inflammation was elicited by diamond polishing paste, and the prophylaxis paste with fluoride elicited an even greater response. The aluminum polishing paste produced the most severe and persistent tissue response, which was of the granulomatous type. CONCLUSIONS: This finding suggests that foreign body reaction should be considered in a gingivitis that does not respond to plaque control or does not represent a mucocutaneous lesion.

Effect of botulinum toxin on pressure pain threshold and EMG power spectrum of masseter muscle during sustained fatiguing contraction.

OBJECTIVES: The aims of this study were to test the effect of botulinum toxin on a reversible, prolonged, experimental pain and on muscle fatigue in human masseter muscle, both caused by a sustained clench. DESIGN: The masseter muscles were injected with botulinum toxin in 19 subjects and with isotonic saline in 16 subjects. We measured electromyographic activity at maximum voluntary contraction, pressure pain threshold before and after a 70% maximum voluntary contraction clench sustained to pain tolerance, and the median frequency of the electromyographic power spectrum during that clench at baseline and at 1, 2, and 3 mos after botulinum toxin or saline injection. RESULTS: After botulinum toxin injection, the botulinum toxin group had a reduced maximum voluntary contraction for the ensuing 3 mos and smaller decreases in pressure pain threshold from before to after the sustained clench. Also, the change in median frequency from before to after the sustained clench did not significantly differ during the postinjection sessions. However, postinjection, preclench median frequency was lower in the group injected with botulinum toxin. CONCLUSIONS: We interpret the reduced change in pressure pain threshold with botulinum toxin as a clinically modest but statistically significant analgesic effect on this model of acute muscle pain.

Human temporomandibular joint eminence shape and load minimization.

Analysis of previous data suggested the hypothesis that temporomandibular joint (TMJ) eminence shapes develop ideally to minimize joint loads. Hence, we tested this hypothesis in nine females and eight males in each of two groups, with and without TMJ disc displacement. Participants provided anatomical data used in a joint load minimization numerical model to predict, and jaw-tracking data used to measure, eminence shapes. Coordinate data (x,y) of shapes were fit to third-order polynomials for two sessions, sides, and methods (predicted, measured) for each participant. Inter-session data were reliable and averaged. Those with, compared with those without, disc displacement had higher measured shape range (5:1) and left-right asymmetry prevalence (4:1). In 29 symmetrical individuals, ANCOVA and Bonferroni tests compared vertical dimensions (y) at 11 postero-anterior points (x), 0.5 mm apart. Model-predicted and measured shapes were significantly different (P < or = 0.01) near the eminence crest, but joint load minimization was consistent with eminence shape for x < 3.0 mm.

Static and dynamic mechanics of the temporomandibular joint: plowing forces, joint load and tissue stress.

OBJECTIVES - To determine the combined effects 1) of stress-field aspect ratio and velocity and compressive strain and 2) joint load, on temporomandibular joint (TMJ) disc mechanics. SETTING AND SAMPLE POPULATION - Fifty-two subjects (30 female; 22 male) participated in the TMJ load experiments. MATERIAL AND METHODS - In the absence of human tissue, pig TMJ discs were used to determine the effects of variables 1) on surface plowing forces, and to build a biphasic finite element model (bFEM) to test the effect of human joint loads and 2) on tissue stresses. In the laboratory, discs received a 7.6 N static load via an acrylic indenter before cyclic movement. Data were recorded and analysed using anova. To determine human joint loads, Research Diagnostic Criteria calibrated investigators classified subjects based on signs of disc displacement (DD) and pain (+DD/+pain, n = 18; +DD/-pain, n = 17; -DD/-pain, n = 17). Three-dimensional geometries were produced for each subject and used in a computer model to calculate joint loads. RESULTS - The combined effects of compressive strain, and aspect ratio and velocity of stress-field translation correlated with plowing forces (R(2) = 0.85). +DD/-pain subjects produced 60% higher joint loads (ANOVA, p < 0.05), which increased bFEM-calculated compressive strain and peak total normal stress. CONCLUSIONS - Static and dynamic variables of the stress-field and subject-dependent joint load significantly affect disc mechanics.

Oral behaviors checklist: reliability of performance in targeted waking-state behaviors.

AIMS: To assess the consistency of intentional behavioral performance as an index of whether individuals understood the meanings of the behavioral terms of the Oral Behaviors Checklist, which is a self-report scale for identifying and quantifying the frequency of jaw overuse behaviors. METHODS: Surface electromyography was used to measure bilaterally the activity of the masseter, temporalis, and suprahyoid muscles (for assessment of oral behaviors) and the biceps muscles (reference task of biceps curl) in 27 temporomandibular disorder (TMD) cases and 27 controls. Subjects were asked to perform (1) biceps curls to lift 5 weights, with explanation, and (2) 10 oral behaviors (e.g., "clench", "yawn") without explanation. RESULTS: Biceps-curl performance resulted in assignments of excellent or very good for linearity-reliability based on inspection and correlation. Test-retest reliability of the 10 performed oral behaviors generally ranged from 0.6 to 0.98 for all 3 muscle groups, and many tasks had reliability coefficients comparable to those for the biceps curl. Across tasks, elevator muscle reliability of cases was 0.87, compared to 0.75 for controls; group values for opening muscles were similar. CONCLUSION: Individual subjects performed each task at a high level of consistency. Performance was not appreciably altered by being a TMD case versus a control and was not significantly different from the performance level of a reference task, indicating that each individual understood well the meaning of each oral behavior-related word.

Characteristics of electrical activity in trapezius muscles with myofascial pain.

OBJECTIVE: To study the reliability and validity of resting electrical activity from tender areas in muscle. METHODS: In seven subjects with tender areas in their trapezius muscles, electromyographic (EMG) signals were obtained from monopolar needles at various depths over the tender area and at the same depths over the control area, and from surface electrodes. At selected depths, multiple epochs were recorded. RESULTS: Increased electrical activity occurred from the electrode inserted toward the tender area in all seven subjects (to a mean of 47.6 microV), but not from control areas. The depths of the maximal EMG amplitudes advancing and withdrawing the needle were usually within 3 mm. The EMG amplitude from the first of multiple epochs (38.4 microV) did not differ from the average (40.0 microV) of subsequent epochs (paired-t test, 6 df, 0.2